A Tip: How to Get Rid of Knee Pain

Have you ever met someone in your life that refuses to learn anything new? These people tend to get under my skin more than Digger the Dematophyte ever could. Even stupid things can make us smarter, which I try to read as much as I can with the little free time I have. One man I have great respect for will scour at the mention of T-Nation. He doesn’t read it. He won’t read it. He has his reasons, and I have great respect for them. I, on the other hand, visit the website on occasion and usually catch up with the most recent articles. I don’t think it’s the greatest source of information, but any website that can lure in Dan John surely will grab my attention.

I came across an article today that bothered me enough to get me away from the TV during Seinfeld (this is a very hard task). I have nothing against the author, but I have everything against the information presented. The article is entitled, “What's Your Weak Link? 3 Solutions to Strength Plateaus,” and is written by Lee Boyce.

My History With Knee Pain

For those of you that have been loyal enough to follow me for the past year know that I used to own a blog entitled, Simply Strong. One of my biggest productions on this blog was my Mighty Steel Knee series that now is being used to serve as the skeleton for the book I am writing. To prevent you reaching for another coffee, here is the reader’s digest version: I have struggled with knee pain my whole life, and after vigorous experimentation I devised a way to get rid of it, the end. I detailed the method and threw it online. I received enough positive replies that it made me feel confident enough to expand on it even further (hence the book).

Lee Boyce presents one of the heaviest misconceptions (in my eyes) about knee pain in the article I referenced above. In the article, there are numerous references to the all powerful VMO. To Lee’s credit, it’s not the only place where you can find information on VMO and its relationship with knee pain. Other gurus and people I know have advised me countless times to focus on the VMO. After a few months worth of experimentation, I found the VMO to be a big hoax. One so big, even Nixon couldn’t pull it off.

Let the Games Begin

I hate to tear down Boyce’s article, because I don’t know the guy. Nevertheless, when you publicly present information you have to be ready for other's opinions. Consider this my drive by shooting.

After taking a critical look at VMO strengthening exercises and claims, the two do not add up. Boyce states that the lower the squat the better and the less stability the better. Yet, the strengthening exercises (Peterson Step Ups and TKE’s) consist of top end range of motion movements with a lot of stability. Both are in stark contrast which should be the first red light in your critical evaluation.

Secondly, Boyce claims that the VMO is essentially shut off which causes the rest of the quadriceps muscles to take the slack of the VMO which in turn puts more stress on the patellar tendon. All of the muscles of the quadriceps are connected to the patellar tendon so how could more stress be placed on the patellar tendon? Stress is a constant thing and doesn’t vary because muscles may not be working or firing properly. If anything, the lack of firing would place more stress on the tendon because the VMO isn’t doing its job, not because the rest of the muscles take the slack.

When In Doubt, Look Elsewhere

What boggles my mind about knee pain is that people refuse to look in different areas for the root of pain. Dissecting the VMO like it’s a slide in your high school Biology class will only get you so far. If writer is unhappy with how a certain paragraph is going, rarely will he or she spend hours reworking one sentence. In all likelihood, the entire paragraph (as well as what came before) will be examined, tweaked, and changed. The same process needs to happen when we take a look at our knee.

Since I’m a nice guy, I’ll let you in on my million dollar theory. I can almost assure you that your knee pain isn’t a result of a malfunctioning VMO but rather a malfunctioning hip. Boyce states the lack of VMO activity will increase patellar tendon stress, I disagree. It’s not the knee. In fact, we owe the quadriceps an apology, VMO included. Perhaps the glove didn’t fit after all.

Chain Reactions

Go back to your high school physics class. No, not the part where you starred in the girl that sat three seats in front of you. Not even to the other girl four seats up and two to the left. What I want you to remember is the concept of force transfer. All force must travel up and down the kinetic chain before being dissipated or expelled.

Our glutes are the powerhouse of our lower body. They are the largest, nearly injury free muscle in our body. Anytime we move, the force (think of it as electricity passing through our legs) must pass through our glutes. Since the vast majority of humans have sub-par glutes, think of there being a bypass of the hip during the electrical transfer. Instead of force being potentially dealt with at the hip-knee-ankle complex, it now only has the knee-ankle complex. Since the knee is the next thing in line on the chain, it only makes sense that it would take the majority of the load. This is where our seemingly never ending source of knee pain comes from. Getting rid of it is a process in and of itself. To give you an example, I’ve been writing about just that topic for months with no clear end in sight.

A Matrix Like Decision

You have a decision to make. You can choose to blame the small, relatively weak VMO or the large, vastly powerful glutes for your dysfunction. Take a critical look at VMO exercises—end range of motion knee extension. How can knee extension exercises fix a problem that occurs during knee extension? I’ll let you decide.

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Comments on this entry are closed.

Gianpaolo MerelloOctober 2, 2010, 8:36 pm

I never read your steel knee series, but the fact that knee problems are derived from hip problems is actually enlightening. I’ve been injured from my right hip joint for about 5 months now, and coincidentaly my right knee is now cracking when I extend it. No pain or anything, but the abnormality is there. And yeah, i was told to train the VMO to get rid of it.

hahah yes I remember you posting it on TT/TS. My condition is not nearly as extreme. Awesome recovery then man, mad props. I’m just starting hip treatement, and will follow your guide if the cracking persists!

I have had patellar tendonitis for 4-5 years now. To keep a long story short, only within the past 6 months have I actually been able to make headway on solving this problem. And yes, VMO work is the main thing that helped me.

I know that my hips work just fine, as I am glute-dominant; my glutes do all the work when I squat, deadlift, or jump. However, my knee pain practically disappeared after warm-up and VMO activation. Initially using leg extensions to achieve this, I resorted to doing full-squats, both bodyweight and front-squat variations, which did an even better job of activating all the right muscle.

For the first time ever, I was finally developing the inner quad muscle (my outer quads had been overdeveloped for years before). So I cannot say I fully disagree with Boyce’s opinions. As for a scientific reason why a misfiring VMO would wreak havoc on the tendon, I think it is the asymmetrical pull of the quads when the VMO is inactive. This concentrates tension on one side of the tendon, causing it to break-down. In turn, this reduces the total available stress-area, as the tendon deteriorates.

I am in no way trying to disparage your opinions on the inner workings of the body. I just provided my own, first-hand, researched point-of-view on this issue. Perhaps the majority with hip problems would be better helped with glute-strengthening. Keep up the good work!!

Anthony, this has to be by far one of my favorite blogs of all time and i´ve just spent the last half an hour on it! amazing insight, great writing! just wanted to ask you 2 things:

1- I´ve been doing this excercise for the past 2 weeks and experienced a relief on my jumper´s knee condition (yes, basketball over here, 33 yo) -by the way i´ve been taking care of my knees for the last couple of years- what´s exactly what i´m working here?

[…Lie on your back with both feet flat on the floor just below your knees. Start with the leg that has the least knee discomfort or pain. Keeping both knees at the same height, extend that knee until the leg is straight and at the same height as the resting knee. Turn the foot of the extended leg outward. If it’s your right leg that’s extended, turn the foot to the 1:00 o’clock position. Hold that position for as long as possible, working toward one minute. Switch and repeat the same exercise for the opposite leg…]

and 2- We need that book man! are you close on making it available? if not…how can i get those vintage Steel Knee series?

Hey Anthony!!! i sure will tell other people about your site because, you know, it´s really really inspiring; we need a whole lot of education on how our body works, how to fine tune it and resolve the modern day damage we inflict on ourselves. If one day you came to Mexico trust me you would scream in disbelief of all the wrong practices we have…5 years ago i ruptured mi left patellar tendon and while i had good surgery, in rehab nobody told me what to eat, how to strengthen my body, how to prevent future injuries etc. Now what i´m learning has me in total amazement, it´s a crime to live in the dark about the way this incredible machine works specially if we love physical activities.

About the exercise, no video around man…it´s very simple, it´s not like a bridge because your butt and back never leaves the ground: one foot close to it and in the ground(knees bent) and the other flexes at the knee leaving that foot pointing to the sky, the you rotate it without rotating the hip…it has helped me so much in getting rid of that pain (but no completely) and i just wanted to know from an expert what´s exactly going out here (a similar exercise it´s done by bill parravano -amazing guy- on one of his posts, http://bit.ly/mH4fjD )

By the way, thanks for the 12 tips, again, you have a really original way of adressing this common problem: i have to tell you that i´m about to try the hip solution, it´s something that i never heard before and i´m really excited to see how that turns out for me!

I have taken it upon myself to read your whole blog, starting from this first post, so as to digest all of the information you have provided us with. I found your solution to skinny-fatness and now live by your teachings and have found that 1. It works. 2. It makes fora much happier life, including my relationship with my girlfriend who, for a while, was becoming increasingly sick of meal preparation on a day to day basis.

I have been suffering from crepitus in my knees for like 5 years.. Im 24 now.. I have super strong glutes, strong vastus lateralis muscle.. But an almost non-exsisting VMO muscle.. And mine is not active when I walk the stairs or do squats.. If I want to active my VMO I have to do a squat hold with abit belove 90 degrees, to make it fire, I can feel it burning in the VMO.. ANd then it gets activated, And I can start to do squats faster .. But after a while.. an hour later.. It shuts off again.. after sitting still or something..
But Its still very weak.. Its just recentley I found out how to actually train your VMO without grinding your cartilage away.. So now im working on making it bigger without destryoing more cartilage.. A wall sit, with ass almost to grass, and abit over 90 degreees, and just feel the VMO work, make it work.. You have to do a bit of testing to find out when it works.. But You can feel it burn quite quickly.. Atleast I can.. Maybe because its so weak compared to the other quad mucscles..

Another thing I want to add is.. Trigger points.. Small muscle knots in your quads.. Reducing range of motion, in the knee..
Trigger points are caused by …. Stress .. Its emotional energi trapped in your muscle tissue, because you are running from old trauma